Measles: Birmingham outbreak declared a national incident and likely to spread

Outbreaks of measles will spread to other towns and cities in the UK without urgent action to increase measles, mumps, and rubella (MMR) vaccination uptake, the UK Health Security Agency (UKHSA) has warned.

On 19 January the agency declared the current outbreak in Birmingham1 a national incident, allowing it to put more resources into tackling the problem.2

As of 18 January there have been 216 confirmed cases and 103 probable cases in the west Midlands since 1 October 2023. Around 80% of those cases have been in Birmingham, with 10% in Coventry, UKHSA said. Most are in children under 10 years old.

On a visit to Birmingham, Jenny Harries, chief executive of UKHSA, said, “Colleagues across the west Midlands have worked tirelessly to try to control the outbreak, but with vaccine uptake in some communities so low there is now a very real risk of seeing the virus spread to other towns and cities.”

NHS figures show uptake of both MMR doses by the age of 5 was 83.7% in the west Midlands, with the figure even lower in London at 74%.3 The World Health Organization recommends vaccine coverage of at least 95% because measles is highly infectious and spreads easily.

Anti-vaccine sentiment is not the whole story behind the low levels of MMR uptake, according to Helen Bedford, professor of children’s health at UCL Great Ormond Street Institute of Child Health. “Although some mistrust of vaccines may play a part, research shows that parental vaccine confidence remains high.” Bedford said that since the pandemic many parents have more questions about vaccination and whether, for a disease like measles which has become rare, it is necessary. She said asking questions should be encouraged but there needs to be trained staff available to answer them and the NHS and general practice are under significant pressure.

Ronny Cheung, officer for health services for the Royal College for Paediatrics and Child Health, said the outbreak is “worrying but not all that surprising.” He said, “The fact remains that vaccination coverage for children under the age of 5 is now the lowest in the past 10 years and outbreaks for diseases like measles are now more likely than ever.”